Fecal continence after rectocele repair: a prospective study

Abstract

Combined transvaginal/transanal rectocele repair was performed in series of 89 consecutive women (mean age 55, range 35-81 years) with obstructed defecation due to a rectocele with a depth of more than 3 cm. The impact of this procedure on anal sphincter pressure and continence status was evaluated prospectively. Anorectal manometry was carried out before and after surgery (at 3, 6, 12, and 24 months). The following measurements were performed: maximal anal resting pressure (MARP), maximal anal squeeze pressure (MASP), and rectal sensory perception including first initial sensation, urge to defecate, and maximum tolerable volumes (MTV). The outcome was successful in 71% of patients with respect to symptoms such as the need for straining at defecation, manual assistance, feelings of incomplete evacuation, sense of rectal fullness, constipation, abdominal pain, and the use of laxatives. However, after rectocele repair seven patients experienced deterioration in fecal continence, and dyspareunia developed in 41% of the sexually active patients. Manometric studies revealed a significant decline in mean of 18% of MARP and 16% of MASP. In contrast to MASP, MARP gradually improved during the follow-up period. Distending volumes required for initial sensation and urge to defecate did not change after the procedure. MTV values were significantly lower 3 and 6 months after rectocele repair than those before and 24 months after surgery. MARP and MASP values after surgery did not differ between patients with impaired and those with normal continence. In conclusion, transvaginal/transanal rectocele repair is beneficial for patients with obstructed defecation; however, care should be taken in sexually active patients, and patients at risk of developing fecal incontinence.

Transanal rectocele repair using EndoGIA: short–term results of a prospective study

“…Mean anal resting pressure was 77 mmHg (SD=7 mmHg) and mean squeeze pressure was 89 mmHg (SD=8 mmHg). No alteration of RAIR was reported; no sign of anismus was founded at balloon expulsion test [13][14][15][16][17][18]. Defecography showed presence and depth of rectocele barium trapping on postevacuation radiography in all cases; mean size of rectocele in these patients at defecography measurements (base x depth) was 4.8 cm x 4.3 cm (range: base, 3.5-6.5 cm; depth, 3-6 cm) ( Table 1).…”

The Impact of Stapled Transanal Rectal Resection on Anorectal Function in Patients with Obstructed Defecation Syndrome

“…This can be attributed both to the reduced time of surgical procedure and also the minimal anal divulsion produced by the use of CAD 33 (36 mm) compared with Park's rectal retractor (which has been associated with transient sphincteric impairment). 37 …”

Changes in Bowel Function following Transanal and Transvaginal Rectocele Repair

“…This group of patients might not benefit from rectocele repair alone in terms of their symptoms related to hemorrhoids. However, transanal repair may compromise anal sphincter pressure, although it is not considered to cause severe fecal incontinence postoperatively [11, 25, 26]. Other studies have not demonstrated any significant reduction of anal sphincter pressure [2, 11, 13, 16, 19], although a few have noted a reduction of threshold volume and/or rectal compliance [2, 11].…”

“…The use of these physiologic investigations would be certainly advisable for comprehensive assessment of anorectal functional disorders. It is generally accepted that surgery for rectocele does not affect anal sphincter function as measured by manometry [1,2,3, 11, 12], though van Dam et al [26] reported a risk of impaired fecal continence after surgery.…”

“…Conversely, transanal repair is typically performed by colorectal surgeons, including a variety of new techniques [1, 2, 4, 8, 9, 11, 13, 16, 19, 25, 26]. This approach makes it possible to perform other procedures concurrently for the correction of simultaneous pelvic floor abnormalities including rectal prolapse/intussusception, fissure, and hemorrhoids [9].…”